Adjuvant chemotherapy for breast cancer: side effects and quality of life.

Palmer, B V; Walsh, G.; McKinna, J A; Greening, W P

doi:10.1136/bmj.281.6255.1594

Cited by 88 publications

(21 citation statements)

References 5 publications

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“…They demonstrated that six or seven months of adjuvant chemotherapy or chemoendocrine therapy improved both quality and quantity of life compared with a short peri-operative course of polychemotherapy in patients with nodepositive breast cancer (265). In a small study of 47 patients, side-effects and QoL were claimed to be impaired for patients receiving a ve-drug combination vs single agent chlorambucil (266).…”

Section: Adju×ant Settingmentioning

confidence: 98%

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

150

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A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This synthesis of the literature on chemotherapy for breast cancer is based on 233 randomised studies, 9 meta-analysis of randomised studies, a population-based cohort study and 18 overviews/retrospective analyses including a total of 155,243 patients. The conclusions reached can be summarised into the following points: Adjuvant treatment-- There is solid scientific support from randomised studies that adjuvant polychemotherapy at 10 years will result in an absolute mortality reduction for patients younger than 50 years by 12% for node positive (34% relative mortality reduction corresponding to an estimated median survival prolongation of several years) and 6% for node negative patients. For women aged 50 to 69 years, the corresponding figures for node positive and node negative patients are 6% and 2%, respectively (approximately 11% relative mortality reduction). Anthracycline-containing combinations result in an absolute survival benefit at five years of 3%, compared with non-anthracycline based polychemotherapy. There are indications that the taxane paclitaxel may further improve the survival compared with anthracyclines. However, the limited data preclude conclusions for the routine care. The addition of tamoxifen to chemotherapy further enhances the survival benefit for receptor positive subgroups. The roles of more dose-intensive regimens, including high-dose therapy with stem cell support, are presently studied in randomised investigations. The data presented so far are conflicting but they do not in general support high-dose therapy. Quality of life, based on analyses of randomised studies, demonstrate that adjuvant polychemotherapy has an initial detrimental effect, but long-term follow-up of treated patients demonstrates no impairment of quality of life compared with untreated patients. Polychemotherapy in standard doses should be offered to premenopausal node positive patients, and the corresponding postmenopausal group with a receptor-negative breast cancer and to node negative patients with high risk factors. Polychemotherapy should be combined with tamoxifen to all patients with receptor-positive tumours. Due to a need of more knowledge in this field, patients should be included in investigational protocols. Locally advanced breast cancer-- Based on current knowledge, treatment of patients with locally advanced breast cancer should include neoadjuvant/preoperative polychemotherapy since there is evidence from controlled studies that such therapy will statistically significantly increase the number of patients who can be offered breast-conserving surgery. Indirect comparisons also demonstrate survival improvements, but the scientific support is equivocal. Metastatic breast cancer-- The median survival for patients with metastatic disea...

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Section: Adju×ant Settingmentioning

confidence: 98%

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

150

View full text Add to dashboard Cite

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“…Chemotherapy for early breast cancer is associated with side‐effects, which may result in increased need for presentation to the emergency department (ED). Significant chemotherapy toxicity can affect patients’ quality of life, compromise effective chemotherapy delivery and increase healthcare resource utilisation . In an Australian study, breast cancer was the most common solid organ cancer diagnosis in oncology patients presenting to ED .…”

Section: Baseline Characteristics and Treatment Details Of All Patienmentioning

confidence: 99%

Emergency department presentations in early stage breast cancer patients receiving adjuvant and neoadjuvant chemotherapy

Tang

Horsley

Lewis

2018

Internal Medicine Journal

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(Neo)adjuvant chemotherapy for early stage breast cancer is associated with side‐effects, resulting in increased emergency department (ED) presentations. Treatment‐related toxicity can affect quality of life, compromise chemotherapy delivery and treatment outcomes, and increase healthcare use. We performed a retrospective study of ED presentations in patients receiving curative chemotherapy for early breast cancer to identify factors contributing to ED presentations. Of 102 patients, 39 (38%) presented to ED within 30 days of chemotherapy, resulting in 63 ED presentations in total. Most common reasons were non‐neutropenic fever (17 presentations/27%), neutropenic fever (15/24%), pain (9/14%), drug reaction (6/10%) and infection (4/6%). Factors significantly associated with ED presentation were adjuvant chemotherapy timing compared to neoadjuvant timing (P = 0.031), prophylactic antibiotics (P = 0.045) and docetaxel‐containing regimen (P = 0.018).

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“…The focus was on determining if one treatment offered a QOL advantage over another equally efficacious regimen. During this period, results of quantitative clinician assessments of patient functionality were reported [11], patients were asked to judge the quality of their lives [12], and the ideas of operationally defining QOL for uniform measurement and the need to measure QOL longitudinally for a complete understanding of the impact of treatment were introduced [7]. …”

Section: The Evolution Of Patient Report: a Brief Historymentioning

confidence: 99%

Measuring symptoms as a critical component of drug development and evaluation in hematological diseases

Williams

Yücel

Cortés

et al. 2013

Clinical Investigation

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With the rapid development of new therapies for patients with hematological malignancies, there is an increasing need for patient report of symptom status during all phases of drug testing. The patient’s perspective on new treatments reflects treatment tolerability as well as symptom benefit, and may assist patients and clinicians in choosing treatments. Inclusion of patient-reported outcomes, more common in solid-tumor than hematological trials, provides early information about symptoms to guide decisions about appropriate dosing and supportive care needs. We provide a historical overview of the use of patient-reported outcomes and symptom assessment in solid-tumor and hematological drug development, and offer recommendations about methodological issues in the monitoring of symptoms in the drug development process in hematological clinical trials.

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Adjuvant chemotherapy for breast cancer: side effects and quality of life.

Cited by 88 publications

References 5 publications

A Systematic Overview of Chemotherapy Effects in Breast Cancer

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Emergency department presentations in early stage breast cancer patients receiving adjuvant and neoadjuvant chemotherapy

Measuring symptoms as a critical component of drug development and evaluation in hematological diseases

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